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LAT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTNdRIZATION SIGNATURES <br /> ONLY THF OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILL:AN APPLICATION. <br /> 1, the Owner/Agent agree,to defend,Indemnify,and hold harmless the County and its agents, of%ers and employees <br /> or proceeding against the Owner/Agents project. <br /> from any claim,action <br /> 1,further, certify under penalty of perlury that t am(check one); <br /> Legal property owner(owner Includes partner, trustee <br /> application,or ,trustor,or corporate officer)of the pmperty(s)involved in this <br /> O Legal agent(attach proof of the owners consent to the application of the property's Involved In this application and <br /> have been authorised to role on their behalf.,and that the foregoing application statements are true and correct. <br /> Print Name: y � <br /> Signature: Z7 Q <br /> Print Name: Date: <br /> Signature: <br /> Print Name: Date: <br /> .. Signature: Date: <br /> r <br /> Print Name: � � <br /> Signature: <br /> Print Name., Date: <br /> Signature: <br /> Date: <br /> a <br /> ii. <br /> i P <br /> fi <br /> I <br /> • 5 <br /> 1 +r. <br /> e s r I <br /> ... ,,,,,.j. -fi. 4 <br /> T <br /> i <br /> 1:41 PMPA,J.ABB February 1,1 on <br /> -4- <br />